HIV
SECURE THE FUTURE REPORT

RAPE IN SOUTHERN AFRICA, drawn from a research document prepared for Bristol Myers Squibb
SECURE THE FUTURE REPORT: The links between HIV & Sexual Violence and issues in reporting rape & best practices in counseling & training for prevention, care & support in cases of sexual violence.

Report Prepared By:
RACHEL JEWKES, Women's Health Research Unit, Medical Research Council. (RSA)
MARY LYN FIELD & KEERA ALLENDORF: - The International Council for Research on Women. (USA).
LILLIAN KIMANI: - University of Witwatersrand -P&DM (RSA)
20 September 2000

Sexual Violence against Women and Children has clearly been increasingly reported throughout the five Secure The Future countries. It is included in the general context of Violence Against Women and Children which is defined as any act of gender based violence that results in, physical, sexual, or psychological harm or suffering to women and children including threats of such acts, coercion or arbitrary deprivation of liberty whether occurring in public or private life. (UN definition)

In addition to the psychological and physical trauma generated by Sexual Violence Against Women and Children, the context of a growing HIV/AIDS impact is critical as this pandemic poses the single greatest threat to Africa's efforts to achieve its full potential.

African women and children have been particularly hard hit by HIV/AIDS. Among the world's countries hardest hit by HIV/AIDS are South Africa, Botswana, Namibia, Lesotho and Swaziland - the nations that are the focus of Bristol-Myers Squibb's SECURE THE FUTURE program. In Botswana, Namibia and Swaziland, it is estimated that one in four people aged 15-49 is living with HIV/AIDS, most of them undiagnosed. In Botswana, where a quarter of all adults are infected with HIV/AIDS, life expectancy has dropped from 61 five years ago to 47 today, and by the year 2010, the figure is projected to fall below 38. Without HIV/AIDS, it would have been over 66.

In Lesotho, life expectancy in 2010 is projected at under 45, compared with over 65 were it not for the pandemic; in Namibia, the figures are 38 and 70; in South Africa, 48 and 68; and in Swaziland, 37 and 63.

The economic implications of this crisis are staggering. In South Africa alone, HIV/AIDS is expected to cost the country one percent of its gross domestic product by 2005, and to consume three quarters of the nation's health budget.

Leclerc-Madlala from Durban (1997, 2000) published work describing the idea "I don't want to die alone" as a factor influencing rape. There have been several newspaper articles from other parts of the country, which have suggested that certain gang members, once they have discovered they have HIV have set out deliberately to infect other people. There is no data to indicate how common these ideas are and how often they are put into practice. Since most people do not know their HIV status it is unlikely that a large proportion of rapes are caused by this although Leclerc-Madlala writes that most of the young people she interviewed in Durban assumed that they had HIV and acted from that assumption.

The belief that having sex with a virgin can cleanse a man of HIV is one which has wide currency in Sub-Saharan Africa, including South Africa. In one study of health promotion workshop participants, a third indicated that they believed at the start of the workshop that HIV could be cured in this way (Jewkes, Matubatuba, Metsing et al 2000). However, this was not a community based study and the questionnaire was self-administered so the possibility that some people had not heard of it but still guessed an answer could not be ruled out. Furthermore, the extent to which the idea is acted upon, and thus a cause of rape, is unknown. Leclerc-Madlala (1997) described it as a "highly prevalent" idea and has shown that in Durban this is a factor in rape of children, which is an increasing problem. There is other evidence that child rape has increased in recent years (Jewkes & Abrahams 2000) and this may be part of the explanation. In Kwa-Zulu Natal there has recently been a revival of traditional practices of virginity testing. One of the many arguments against this practice is that by publicly identifying some girls as virgins it may make them vulnerable to rape.

Another problem is that fear of HIV drives some men towards seeking very young partners in the belief that they will be free of the virus. In some cases this might involve rape. Leclerc-Madlala (1997) and Mthethwa and Dlamini (2000) describe this practice, but its prevalence of this is not known.

Fear of not being believed is probably also a barrier to reporting rape to interviewers in surveys. In the United States rape has been shown to be more likely to be kept secret than any other form of victimisation (Koss 1993). Women may be unwilling to recall and discuss with an interviewer experiences which were unpleasant and humiliating and may be associated with shame, guilt or fear of blame (WHO 1999).

The role of traditional community structures in reducing sexual violence through ensuring the apprehension and punishment of perpetrators and the role of traditional leaders in acting against perpetrators have not been well explored and documented in research in different cultural settings within the STF countries.

International literature discussing links between rape and HIV includes the following:
Retzlaff, Carmen. 1999. Women, healthcare, and violence: The Ninth International Nursing Conference on Ending Violence Against Women. Journal of the International Association of Physicians in AIDS Care, March issue. (http://www.thebody.com/iapac/violence-women.html.)

Review article on AIDS and violence, most of which concentrates on violence against women with AIDS. The only section on sexual violence leading to HIV infection is the following:
In 1991 a clinic in San Antonio, Texas added the question "Have you ever had a really bad sexual experience, like sexual abuse or rape?" to their entry screening. 31% of the women who entered the clinic answered yes to the question (4)
From this single question they were able to identify a high-risk group for STDs. Women who answered yes had more partners, an earlier age of first sexual experience, engaged in riskier sexual activities, considered themselves more at risk of HIV, were less likely to have been tested for HIV, and had more partners who had sex with commercial sex workers.

UNAIDS. 2000. What Makes People Vulnerable? Report on the Global HIV/AIDS Epidemic.

A clinic in Harare, Zimbabwe, where children who are raped are treated, estimated the percentage of children who acquired HIV as a result of rape. Children who had acquired HIV as a result of rape were defined as children that tested negative when they first arrived at the clinic and seroconverted to HIV-positive status a few weeks later.
Estimates of HIV infection as a result of rape: 5% of 13-16 year olds, 2% of 9-12, 3% of 5-8, and 1% of 0-4 (graph) (< biblio >).

Vogelman, Lloyd. 1990. The Sexual Face of Violence: Rapists on Rape. <br>
Johannesburg, South Africa: Ravan Press Ltd.<br>

In depth study of rape in South Africa through the perspective of men, focusing on the social context, motivations, and feelings of those who rape. The study looked at 27 "coloured" men divided into three groups, rapists, physically violent men, and non-violent men (control group); not all of the rapists had been convicted.

Findings:
The majority of rapists are friends, acquaintances, or husbands.
Rape reflects the masculine social and sexual role of dominance, power, and control or conquest.
Rape stems primarily from men's need to live up to a cultural stereotype of masculinity - men rape because they want to bolster masculine pride and feed their desire for power which is largely attributable to the rapist's need to live up to society's ideals of masculinity - to be aggressive, strong, virile, dominant and all-powerful, need to compensate for feelings of powerlessness stemming from the family; alienation in the workplace and political and racial oppression; socialized belief in rape myths, objectification of women; belief that violence is a way to solve problems. There is a strong association of sex with violence.
If men are violent with women they are intimate with then it is easier for them to be violent with women they don't know.

International literature on links between child abuse and adult risk behaviour includes the following:
Cohen, Mardge, Catherine Deamant, Susan Barkan, Jean Richardson, Mary Young, Susan Holman, Kathryn Anastos, Judith Cohen and Sandra Melnick. 2000. Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV. American Journal of Public Health 90(4): 560-565.

This study looked at the prevalence and effect of domestic violence and childhood sexual abuse in women with HIV or at risk of HIV infection. The study group consisted of 1645 women 13 and older from 6 clinical consortia in various cities in the US.
Relevant findings:
The women at highest risk of domestic violence are demographically similar to women at high risk of HIV infection (560).
There was a high incidence of childhood sexual abuse (30%) in HIV positive women (563)
There was not an association between childhood sexual abuse and HIV seropositivity, but they did confirm association between childhood sexual abuse and high HIV risk behavior (multiple partners, drug use etc.) (563).
Of the women who had been raped by an HIV positive assailant 56% had experienced childhood sexual abuse, implying that childhood exposure to sexual abuse may start a trend of risk-taking
The results support a "continuum of risk - that early abuse leads to later abuse and violence, which may increase the risk of behaviors that lead to HIV infection".

Mthethwa RK, Dlamini TL (2000) Perceptions on child sexual abuse in Swaziland. Swaziland Action Group Against Abuse, Manzini.

Study of child abuse in Swaziland
Women didn't know how to report child abuse, didn't want to believe their daughters, were concerned that the daughters were enjoying sex with their father, not wanting to help as jealous,

Keikelame J, Ferreira M (2000) Mpathekombi, ya bantu abadala: elder abuse in black townships on the Cape flats. Research report published by HSRC/UCT Centre for Gerontology, Cape Town.

Three focus groups with Xhosa-speaking elderly women and men.
Reports of sexual abuse (usually incest) of older persons were spontaneous and outnumbered all other forms of abuse. Rape of elderly by people on streets was described as 'rape', but rape by sons was very rarely viewed as 'rape' even if force was used.
Older victims of abuse are usually unwilling to report especially when the perpetrator is an adult child and/or carer. This is due to dependence but also fear of shame and social censure.

Procek E (1999) Report of a study of rape in Botswana. Commissioned by the Botswana Police Service. Social Welfare and Development Services (Pty) Ltd, Francistown.

Interviews with senior police officers and prosecutors in police stations and review of 1194 reported rape cases:
Rape and "defilement of girls under 16" brought to the police in Botswana has increased from 1995-1998 by 24% and 52% respectively. All crime has increased substantially over this period.
Rape is often preceded by violence and onlookers who do nothing, especially if the people involved are assumed to be lovers, often witness this.
Parents and relatives often decide to deal with cases of rape themselves at home or through customary procedures according to the strength of traditional family and social practices, especially if victim is young and victim and assailant are known closely or related. These cases are usually not reported to the police or if they are they are withdrawn.
Rape cases will not succeed without evidence corroborating the woman's account.
Over half of rapes take place in the home and 58% of assailants are well known to their victim, rapes are often preceded by physical violence and in many cases where the assailant is familiar the women is held hostage and raped repeatedly .
27% of all offences are reported by or on behalf of children under 16
Men, especially, see drunken women, as justified targets of rape.
A woman or girl out alone at night is seen by potential attackers as an easy target who is 'asking for it'. Often men will buy drinks etc. for women and when the women do not have sex they take what they see as their due; male pride and assertion of male control over women 'behaving badly'.
The predominant view of police officers is that rape occurs when women break certain rules or codes of social interaction that exist to protect them from potential male violence.

Women's Affairs Department (1999) Report on the study on the socio-economic implications of violence against women in Botswana. Ministry of Labour and Home Affairs, Gaborone.

The concept of 'marital rape' has been rejected by many fora in Botswana since many men feel that marriage gives them unlimited sexual access to their wives.

Artz L. (1999) Access to Justice for Rural Women: Special Focus on Violence Against Women. Report: Institute of Criminology: University of Cape Town.

Physical barriers to access to the police were important. Barriers include: long distances to police stations, problems finding a working telephone and lack of police transport to visit crime scenes.
Barriers of the police were compounded by a perception that rape is not 'real' crime.
Women reporting rape were faced with a barrage of questions and comments, which were hostile, accusatory and demonstrated a lack of co-operation from the police.
Few district surgeons were available immediately and women had to wait long periods to be examined.

Swart L, Gilchrist A, Butchard A, Seedat M, Martin L. (1999). Rape Surveillance through district surgeon's offices in Johannesburg, 1996-1998: Evaluation and Prevention Implications. Institute of Social and Health Sciences. University of South Africa.

This document describes data collected in an incomplete series of rape cases presenting to medico-legal clinics in Southern and Central Johannesburg from 1996-8. Women were more likely to report rape to the police if the police station and medico-legal clinic were linked and it was known that support services were available at the police station.

Francis V. (2000) A rape investigation in the Western Cape. A study of the treatment of rape victims at the three police stations in the Cape Flats. Bureau of Justice Assistance.

Experiences of 15 women trying to report rape in Cape Town.
Police obstruct attempts to report rape by telling women they are lying, suggesting the woman drop the charge (especially if the rape was committed by a boyfriend), or deciding the evidence is insufficient to proceed with the case
Women were given a letter to a GP or day hospital for an HIV test.

Stanton S, Lochrenberg M, Mukasa V (1997) Improved justice for survivors of sexual violence? Adult survivors' experiences of the Wynberg Sexual Offences Court and associated services. Institute of Criminology, University of Cape Town.

Women found giving statements very distressing with problems of privacy (in this case making women feel vulnerable with male officers), language, police impatience, male officers, not being prepared for very detailed questioning, interruptions and lack of familiarity with the whole process.
Incorrect information - one woman was told she couldn't proceed with her case as she had already been to hospital.

Foster, Lesley Ann. Masimanyane Women's Support Centre. 2000. "Violence against women: The problems facing South Africa." www.ippf.org/resource/gbv/chogm99/foster.htm

Study by Masimanyane Women's Support Centre looked at experience of women reporting rape and domestic violence in the Greater East London area of South Africa
Very few cases reported to the police were referred to the courts; most court cases were struck from the roll or dismissed

Ramokuena MA, The roots of violence against women in Lesotho. Unpublished discussion paper, University of Florida.

Discusses male sexual entitlement in marriage. She writes, "The society of Basotho condones violence against women. If my husband hits me and inflicts injuries on me, I should prepare his meals and serve him despite the disabling condition and pain, and above all have sexual intercourse (which may be forced) with him since sex is a duty or an obligation not for pleasure".

Pauw BA (1963) The second generation. Oxford University Press, Cape Town.

Writing on Xhosa Marriage:
Traditionally marriage resulted from protracted negotiations between the two families with exchange of gifts and lobola
An alternative form of marriage known as ukuthwala is a form of abduction and rape or sometimes the term is used for elopement
Often it takes place with the connivance of the girl's father after he has been formally asked for his daughter's hand and sometimes after lobola payment has been made.

Albert, Jan, Johan Wahlberg, Thomas Leitner, David Escanilla, and Mathias Uhlen. 1994. Analysis of a rape case by direct sequencing of the human immunodeficiency virus type 1 pol and gag genes. Journal of Virology 68(9): 5918-5924.

Report by researchers who successfully provided evidence in a Swedish court case to establish that an HIV positive assailant had infected a woman.
A woman who had seroconverted a few weeks after a rape filed a rape report one year after the rape. The time delay meant there was no medical evidence of the rape so she had to provide evidence to establish that the rapist was the one who had transmitted HIV to her.
Using PCR on two gene sequences (pol and gag) from HIV-1 in both the victim and the assailant, researchers compared the sequences to control sequences and determined that it was highly likely that the assailant had infected the victim.

Facilities and Services Dealing with Sexual Violence in the Following Countries

BOTSWANA:
The Botswana government has acknowledged the seriousness and the magnitude of violence against women. It has formed a Women Affairs Department, which is charged with the responsibility of developing policy guidelines and frameworks to deal with the whole issues of violence against women in Botswana. The department of Women Affairs in conjunction with the office of Attorney General has developed a policy and status on violence against women.

Rape is increasing in rural, semi-urban and urban areas in Botswana, with an average of two cases reported a day. The number of reported case increased from 599 to 1101 between 1986 -1996. In 1997 the reported rape cases stood at 20 percent. It is estimated that the judiciary system and its support service are spending at least 30 per cent on cases involving violence against women. The official figures suggest that rape far outweigh crimes as murder. (Davis, C. and Rossetti, S (1999).

A practical case study dealing with this issue is Maun Rape Crisis Centre. (RCC). The Centre serves a semi-urban community; it seems the Centre has developed an integrated approach to dealing with the sexual violence crisis in that area. The Centre works very closely with other key partners, Maun General Hospital where most of the cases are handled, the Tribal Administration who help in mediation outside the family, The Police, Social Workers, and Magistrates Court who deal with the legal aspect of reported cases of violence against women. RCC offers other support services outside the NorthWest District for abused women; Legal and Emergency shelter.

NAMIBIA:
Namibia is among few countries in the region that have progressive laws regarding violence against women. But despite of all the great efforts, the number of reported cases on domestic and sexual violence is at increase. A study by the Women and Law Committee shows that the violence against women and children is widespread. The number of reported rape cases in Namibia has increased steadily over the last few years. According to police report, there were 352 reported rapes in Namibia in 1988, growing steadily to 445 in 1990. The rate of rape cases rose dramatically in 1993 (611) and in 1994 (740) Namibia Police " Reported Rape and Attempted Rape Cases by Police District" 1992 -1994. A case study quoted a woman saying, "A woman is not safe anywhere, not in the streets, not in a taxi, not even in their houses" (LeBeau, D 1997 "The changing status of Women in Namibia and Its Impact on Violence against Women".

Poverty, unemployment and high rate of alcohol abuse has been attributed as the major contributing factors to violence against women. Other factors that play an important role are women's general unequal social status and misunderstood cultural norms.

The Women and Legal Committee and the Legal Assistance (LAC) have drafted a new sexual assault bill. The Namibia government last year finally published the long awaited Bill preventing violence against women. There are other key plays that are dealing with the issues of sexual and family violence against women in all both rural and urban communities in Namibia.

SOUTH AFRICA:
The violence against women and children is wide spread in South Africa and the current research data on the issues give a very gloomy picture. It is estimated that a woman is raped every 35 second and one of two women will be raped in their lifetime in South Africa.

Since the introduction of a Democratic Government in 1994, a number of laws have been passed to protect women and children. Some of the government and organisations opposed to violence against women and children have recommended a number of changes. Domestic violence is now a criminal offence falling under the jurisdiction of magistrate and not traditional courts. However, preliminary research results suggest that while black rural women prefer domestic violence cases to be dealt with by magistrate courts, in practice they report such cases to traditional courts. (CALS -Wits University "Traditional Courts and Domestic Violence" The Gender Research Project Report VOL/4/99.

The challenge is if rural women believe that magistrate courts handle domestic violence cases better, why then do they bring such cases to traditional structure? Are the magistrates' courts trained and prepared to handle such case?

There are many NGO as well as government departments dealing directly on the issues of gender violence against women and children in South Africa, offering a variety of services. These services include crisis counseling, peer support group, shelters, medical and social service, legal clinic etc. What is lacking is a more integrated approach, which will lead to more collaboration among the key plays dealing with this natural crisis.

SWAZILAND:
Swaziland government is faced with a major problem of increased number of reported cases in child sexual abuse in the last few years. Studies conducted to assess the perception on child sexual abuse in Swaziland by the Swaziland Action Group Against Abuse (SWAGAA); a non-governmental organisation shows that there are still myths and misconceptions about child sexual abuse. Some of these myths play a major role in contributing to increase of children sexual abuse in most of the communities in Swaziland.

The SWAGAA study January 2000, identified some of the commonly used justification for increase cases in child sexual abuse: - children do not have AIDS, thus they were used for cleansing to cure HIV/AIDS. This kind of perception and belief make all children in the society vulnerable victims and threaten the wellbeing and the future of the nation. The study also gathered from the respondents that the category of abusers includes priests, police, fathers, teachers, etc. SWAGAA, one of leading women organisation playing a key role in creating awareness on sexual abuse of children and women in Swaziland. SWAGAA's activities focus mainly on education and counseling. In additional to this, the organisation is committed to advocacy and research. Study conducted by SWAGAA in 1998 revealed that more than 50% of sexual abused cases reported for counseling were aged below 21 years. (Cases of rape and incest: below 10 years =18, above 10and below 18yrs =31 and above 18 years = 40 Total of 89 cases) SWAGAA study report January 2000.

This statistics implies that the cases of children sexual abuse seem to be on the increase in Swaziland. There is need for further empirical study to investigate the problem further, the study on child sexual abuse should focus on the impact of the survivors (victims). It is the views of SWAGAA that such research would assist organisations and government with useful data that would inform the policy formulation, improve the provision of services, lobbing for law reform and developing of strategies for dealing with the problem of sexual violence in Swaziland.

The study makes the following recommendations:
The government to review and enforce its laws regarding the sexual abuse of children,
The government to invest in training of professionals involved in handling cases of child sexual abuse,
Provide shelters for women and children living in abusive situation,
Support the effort of NGO's providing assistance to abused women and children.

The services available in Swaziland for children who are sexually abused depend on the availability of professional personnel e.g. legal practitioners, teachers, health workers and counsellors who are well trained to deal with the issues of sexual abuse of children. In most of the cases some of these professionals are over worked, they're not provided with proper ideal facilities to conduct counseling.

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